Journal of Clinical Orthopaedics | Vol 7 | Issue 2 | Jul-Dec 2022 | page: 73-77 | Alwar Thiagarajan, Ayyadurai Prakash, Gopalakrishnan Janani, Rao Vikram, Sivaraman Arumugam
Author: Alwar Thiagarajan , Ayyadurai Prakash , Gopalakrishnan Janani , Rao Vikram , Sivaraman Arumugam 
 Centre for Sports Science, Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher
Education and Research, Chennai, Tamil Nadu, India.
Address of Correspondence
Dr. Ayyadurai Prakash,
Centre for Sports Science, Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher
Education and Research, Chennai, Tamil Nadu, India.
Sudden cardiac death (SCD) is the biggest challenge of all sports emergencies, as it is the leading cause of preventable deaths in both professional and recreational athletes. There is also an ongoing concern about COVID-19-associated cardiac pathology among athletes because myocarditis is an important cause of SCD during exercise. Hypertrophic cardiomyopathy represents 24% of SCD and Sudden Unexplained Death (normal heart at autopsy) represents 34% of SCD. To make sports participation safer, it is important to synergistically combine primary prevention of SCD by pre-participation identification of athletes affected by at-risk cardiomyopathies and secondary prevention with backup defibrillation of unpredictable sudden cardiac arrest on the field. The prompt application of an automated external defibrillator itself is associated with a greater likelihood of survival. With the advancement in the field of sports cardiology, the implantation of implantable cardioverter defibrillator has been promising in getting the athlete back on the field including in contact sports. Hence, knowledge of primary and secondary prevention is of great importance in reducing the incidence of SCD as well as improvising existing strategies.
Keywords: Athlete’s heart, preparticipation cardiac screening, on-field death, cardiac arrest, ECG changes.
- Emery MS, Kovacs RJ. Sudden cardiac death in athletes. JACC Heart Fail 2018;6:30-40.
- Terlep S. Getting to the Heart of the Matter: Should NCAA Require EKG Testing? New York: Wall Street Journal; 2015. Available from: https://www.wsj.com/articles/getting-to-the-heart-of-the-matter-should-ncaa-require-ekg-testing-1432749315 [Last accessed on 2022 Mar 16].
- Eckart RE, Shry EA, Burke AP, McNear JA, Appel DA, Castillo-Rojas LM, et al. Sudden death in young adults: An autopsy-based series of a population undergoing active surveillance. J Am Coll Cardiol 2011;58:1254-61.
- Evéquoz D, Zuber M, Erne P. Sudden cardiac death: definition, mechanisms and risk factors. Praxis (Bern 1994) 1996;85:188-96.
- Asif IM, Harmon KG. Incidence and Etiology of sudden cardiac death: New updates for athletic departments. Sports Health 2017;9:268-79.
- De Noronha SV, Sharma S, Papadakis M, Desai S, Whyte G, Sheppard MN. Aetiology of sudden cardiac death in athletes in the United Kingdom: Apathological study. Heart 2009;95:1409-14.
- Harmon KG, Asif IM, Maleszewski JJ, Owens DS, Prutkin JM, Salerno JC, et al. Incidence, cause, and comparative frequency of sudden cardiac death in national collegiate athletic association athletes: A decade in review. Circulation 2015;132:10-9.
- Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: Analysis of 1866 deaths in the United States, 1980-2006. Circulation 2009;119:1085-92.
- Egger F, Scharhag J, Kästner A, Dvořák J, Bohm P, Meyer T. FIFA sudden death registry (FIFA-SDR): A prospective, observational study of sudden death in worldwide football from 2014 to 2018. Br J Sports Med 2022;56:80-7.
- Barretta F, Mirra B, Monda E, Caiazza M, Lombardo B, Tinto N, et al. The hidden fragility in the heart of the athletes: Areview of genetic biomarkers. Int J Mol Sci 2020;21:6682.
- Albaeni A, Davis JW, Ahmad M. Echocardiographic evaluation of the Athlete’s heart. Echocardiography 2021;38:1002-16.
- George K, Whyte GP, Green DJ, Oxborough D, Shave RE, Gaze D, et al. The endurance athletes heart: Acute stress and chronic adaptation. Br J Sports Med 2012;46:i29-36.
- D’Souza A, Bucchi A, Johnsen AB, Logantha SJ, Monfredi O, Yanni J, et al. Exercise training reduces resting heart rate via downregulation of the funny channel HCN4. Nat Commun 2014;5:3775.
- Beaudry R, Haykowsky MJ, Baggish A, La Gerche A. A modern definition of the athlete’s heart-for research and the clinic. Cardiol Clin 2016;34:507-14.
- Asif IM, Rao AL, Drezner JA. Sudden cardiac death in young athletes: What is the role of screening? Curr Opin Cardiol 2013;28:55-62.
- McKinney J, Johri AM, Poirier P, Fournier A, Goodman JM, Moulson N, et al. Canadian cardiovascular society cardiovascular screening of competitive athletes: The utility of the screening electrocardiogram to predict sudden cardiac death. Can J Cardiol 2019;35:1557-66.
- Johri AM, Poirier P, Dorian P, Fournier A, Goodman JM, McKinney J, et al. Canadian cardiovascular society/Canadian heart rhythm society joint position statement on the cardiovascular screening of competitive athletes. Can J Cardiol 2019;35:1-11.
- Weisfeldt ML, Sitlani CM, Ornato JP, Rea T, Aufderheide TP, Davis D, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: Evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol 2010;55:1713-20.
- Kim JH, Levine BD, Phelan D, Emery MS, Martinez MW, Chung EH, et al. Coronavirus disease 2019 and the athletic heart: Emerging perspectives on pathology, risks, and return to play. JAMA Cardiol 2021;6:219-27.
- Maron BJ, Udelson JE, Bonow RO, Nishimura RA, Ackerman MJ, Estes NA, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 3: Hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: Ascientific statement from the American heart association and American college of cardiology. Circulation 2015;132:e273-80.
- Corrado D, Drezner J, Basso C, Pelliccia A, Thiene G. Strategies for the prevention of sudden cardiac death during sports. Eur J Cardiovasc Prev Rehabil 2011;18:197-208.
- Patel A, Lantos JD. Can we prevent sudden cardiac death in young athletes: The debate about preparticipation sports screening. Acta Paediatr 2011;100:1297-301.
- Lampert R. Sport participation in patients with implantable cardioverter-defibrillators. Curr Treat Options Cardiovasc Med 2019;21:66.
- Saarel EV, Law I, Berul CI, Ackerman MJ, Kanter RJ, Sanatani S, et al. Safety of sports for young patients with implantable cardioverter-defibrillators: Long-term results of the multinational ICD sports registry. Circ Arrhythm Electrophysiol 2018;11:e006305.
|How to Cite this article: Thiagarajan A, Prakash A, Janani G, Vikram R, Arumugam S. Prevention and Management of Sudden Cardiac Death in Athletes. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):73-77.|